Healthcare Provider Details

I. General information

NPI: 1932656097
Provider Name (Legal Business Name): CONNECT AND MOVE STAFFING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 BOWMAN ST
CLERMONT FL
34711-3143
US

IV. Provider business mailing address

1217 BOWMAN ST
CLERMONT FL
34711-3143
US

V. Phone/Fax

Practice location:
  • Phone: 386-212-2061
  • Fax:
Mailing address:
  • Phone: 386-212-2061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JERRY TAYLOR
Title or Position: MANAGER
Credential:
Phone: 386-212-2061